August 30, 2007
Perversity
No, this is not an update on Republican Senator Larry Craig and the Minneapolis airport bathrooms. This will be a quick post on medical perversity, particularly as it relates to financial incentives for physicians. As I’ve noted before, patients would be mortified if they knew the financial calculations going on inside their doctor’s head when they thought they were devising a treatment plan.
A report published online yesterday in the Journal of the American Academy of Dermatology is an excellent example of perverse financial incentives for doctors. As reported here in the New York Times:
Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared with a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.
That’s right. We’ll see you right away to smooth those wrinkles, but cancer…sorry…you people have to wait for the next available appointment. The reason, of course, is money. Dermatologists receive $400 to $600 dollars (cash only please) for botox treatments. They receive much less for a mole check (the article reports $50 to $75).
This is a medical example of the hypercompetitive free-market. Remember, in healthcare free-market competition rarely leads to better health outcomes. In fact, perverse financial incentives for doctors frequently lead to worse health outcomes. Over-treatment, excessive testing, unnecessary procedures…but all reimbursable!
I’m not picking on the Dermatologists. Every medical specialty has similar perverse financial incentives (including my own, Internal Medicine). Most doctors I know are conscientious and compassionate. But there are financial factors in play that doctors and patients would be well advised to remember. The desire to maximize profits is powerful.
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6 Comments Add yours »
Re: your opening sentence.
Just to make sure we’re clear…you guys at NC Policy Watch believe that what Senator Craig is “alledged” (snicker) to have done in the lavatory was in fact, “perverse?”
Just wondering.
More like a crime, to which he has already admitted guilt.
Yup, Jim, that was a “gotcha” moment. I guess I’ll have to surrender my liberal bona fides for not approving solicitation of sex in a public bathroom.
Just a note, in the report on Princess Diana’s death that just came out, they noted that she probably would not have died if the accident had happened in the U.S. It turns out that the French could not give her medical treatment quick enough. Here in the U.S. she would have been rushed to an emergency room. In France, they try to avoid going to the hospital (I would assume to avoid the long lines) and instead try to stablize the victim at the scene. She died several hours after the accident from untreated internal bleeding. I would hate to see what happens to the average citizen in France when even visiting royalty can’t get quick treatment…
Source? Fox News?
I heard this on one of the broadcast news stations. I’m a broke college student, I can’t afford cable.